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MONITORING OF NUTRITION IN

ICU

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A slender and restricted diet is always dangerous

in chronic and in acute diseases

Hippocrates 400 B.C.

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>40% of hospitalpatients malnourishedon

admission

McWhirter and Pennington 1994

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donotlet yourpatientsstarveand when you

offerthem nutritionsupport,doso by thesafest,

simplest, mosteffective route.

Dr Mike Stroud Feb 2006

Chairof NICE committee

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Monitoring

Shortterm

Blood

biochemistry

FeedvolumereceivedVs

Feedvolumeprescribed

Bowel motion & gastricaspirate

Any changesinstress/patientactivity

Longterm

Weight

Traceelements

Urinary urea

Urinary electrolyte

Anthropometric measurements

Indirectcalorimetry

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Physicalexamination

Examineregularly

Nutritionalstatus

Weightshould be measureddaily Hydrationstatus

Reasonablepredictorof body fatandcaloric

balance

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Functionalassessment

Repletionofproteinandenergy reservesis

associated with:

IMPROVEMENT IN FUNCTIONAL ABILITIES

Gripstrength

Activity level Physicalendurance

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Laboratory test

Useful for monitoring individual patient responses to

parenteral and enteral nutrition support

Metabolicstate

Protein energy balance

Micronutrition status

Fluidandelectrolyte

Acid base balance Organfunction

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Parenteral only

Chemsticks 6 hourly

iCa Every alternateday ( until

stable)

Alkaline Phosphatase Weekly

AST Weekly

Total Bilirubin Weekly

Triglyceride Asneeded

PT Asneeded

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Blood biochemistry

C-reactiveprotein

Bloodelectrolyte Na+,K+,

Blood Urea Nitrogen (BUN) LFT

Bloodglucose

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Nitrogen balance

Usefulindeterminingindividualproteinrequirement

Nitrogen Balance = Nitrogen Intake Nitrogen Output

Nitrogen intake =feedreceivedin 24 hours (enteral/parenteral/oral)

Nitrogen output=urinary urea/mmol/24 hoursx 0.033 +obligatory losses+

any extrarenallosses

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Protein Energy Balance

During periods of inadequate dietary protein or energy, a reduction

in hepatic synthesis and secretion of these proteins causes plasma

levels to fall.

Transthyretin

previously known as prealbumin

Half life of 2 days ( rapidly respond to nutrition balance)

Transferrin

Retinol binding protein

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Vitamins & Minerals

Micronutrientsin wound healingandimmune

function may needto be monitoredtoassurethe

adequacy ofsupplementation

Zinc

Vitamin C

Copper

Magnesium

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THANK YOU